MR Microinsurance_2012_03_29.indd - International Labour ...

78 Emerging issues
among members of China’s NCMS. More specifically, they could not discern
among the poorest 10 per cent of the scheme’s subscribers the significant positive
impact on outpatient or in-patient care-seeking behaviour that was evident
among members in other income deciles. Despite the results from the latter
study, the evidence tentatively suggests that, with the barrier of joining behind
them, scheme members enjoy some degree of economic equality in accessing
benefits.
Of the studies evaluated here, five examined spatial equity through enrolment
and utilization rates. Regarding enrolment, for example, Chankova et al.
(2008) performed regressions to determine that the presence of nearby health
facilities positively influenced microinsurance enrolment in Senegal and Mali,
which was not addressed in surveys involving Ghana’s Nkoranza scheme. Similarly,
Wagstaff et al. (2009) used probit analysis to establish that “households living
far away from facilities are less likely to enrol” in China’s NCMS, but noted
that “increasing distance reduces the probability only up to a point”. Regarding
utilization, similar results were obtained among Equity Initiative members; for
instance, Franco et al. (2008) found that distance to the health facility was a significant
negative predictor for healthcare seeking, particularly regarding assisted
deliveries. In Rwanda, Schneider and Diop (2001) also established that members
of 54 community schemes visited providers directly according to their geographical
ease of access. While limited in number, these results suggest that the policies
under consideration have not effectively addressed distance-based discrepancies
in access to insurance and service utilization.
Evaluators have studied two key questions relating to gender inequities: how
microinsurance enrolment and access to services varies by gender, and whether
plans that cover women’s health concerns result in better outcomes by gender
than have been historically obtained. Regarding the first issue, researchers have
reached varying conclusions on the rates at which women, or households headed
by females, purchase microinsurance. In Ghana, Mali and Senegal, Chankova et
al. (2008) determined that households headed by females were more likely to
enrol after taking account of other factors, while in Rwanda, Schneider and Diop
(2001) could find a statistically significant effect. Wagstaff et al. (2009) established
that the gender of a household’s head was unrelated to its likelihood of
joining China’s NCMS. Schneider and Diop (2001) were the only ones to disaggregate
members’ care-seeking behaviour by gender and they found that the
probability of visiting a provider did not vary by sex for policyholders in
Rwanda.
In terms of women’s health outcomes the results were likewise mixed, Aggarwal
(2010) found no appreciable impact of India’s Yeshasvini scheme on maternal
health care, while Franco et al. (2008) observed that members of Mali’s Equity
Initiative were twice as likely to make four or more prenatal visits as women in